Name /bks_53161_deglins_md_disk/atenolol
02/17/2014 01:35PM
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Tenormin
Classification
Therapeutic: antianginals, antihypertensives
Pharmacologic: beta blockers
Pregnancy Category D
Indications
Management of hypertension. Management of angina pectoris. Prevention of MI.
Action
Blocks stimulation of beta1(myocardial)-adrenergic receptors. Does not usually affect beta2(pulmonary, vascular, uterine)-receptor sites. Therapeutic Effects:
Decreased BP and heart rate. Decreased frequency of attacks of angina pectoris. Prevention of MI.
Pharmacokinetics
Absorption: 50– 60% absorbed after oral administration.
Distribution: Minimal penetration of CNS. Crosses the placenta and enters breast
milk.
Metabolism and Excretion: 40– 50% excreted unchanged by the kidneys; remainder excreted in feces as unabsorbed drug.
Half-life: 6– 9 hr.
TIME/ACTION PROFILE (cardiovascular effects)
ROUTE
ONSET
PEAK
DURATION
PO
1 hr
2–4 hr
24 hr
Contraindications/Precautions
Contraindicated in: Uncompensated HF; Pulmonary edema; Cardiogenic shock;
Bradycardia or heart block.
Use Cautiously in: Renal impairment (dosageprecommended if CCr ⱕ35 mL/
min); Hepatic impairment; Geriatric patients (qsensitivity to beta blockers; initial
dosageprecommended); Pulmonary disease (including asthma; beta selectivity may
⫽ Genetic Implication.
pg 1 # 1
be lost at higher doses); Diabetes mellitus (may mask signs of hypoglycemia); Thyrotoxicosis (may mask symptoms); Patients with a history of severe allergic reactions
(intensity of reactions may beq); OB: Crosses the placenta and may cause fetal/neonatal bradycardia, hypotension, hypoglycemia, or respiratory depression; Lactation: Pedi: Safety not established.
atenolol (a-ten-oh-lole)
⫽ Canadian drug name.
Plate # 0-Composite
Adverse Reactions/Side Effects
CNS: fatigue, weakness, anxiety, depression, dizziness, drowsiness, insomnia, memory loss, mental status changes, nervousness, nightmares. EENT: blurred vision,
stuffy nose. Resp: bronchospasm, wheezing. CV: BRADYCARDIA, HF, PULMONARY
EDEMA, hypotension, peripheral vasoconstriction. GI: constipation, diarrhea,qliver
enzymes, nausea, vomiting. GU: erectile dysfunction,plibido, urinary frequency.
Derm: rashes. Endo: hyperglycemia, hypoglycemia. MS: arthralgia, back pain,
joint pain. Misc: drug-induced lupus syndrome.
Interactions
Drug-Drug: General anesthesia, IV phenytoin, and verapamil may cause additive myocardial depression. Additive bradycardia may occur with digoxin. Additive
hypotension may occur with other antihypertensives, acute ingestion of alcohol,
or nitrates. Concurrent use with amphetamine, cocaine, ephedrine, epinephrine, norepinephrine, phenylephrine, or pseudoephedrine may result in unopposed alpha-adrenergic stimulation (excessive hypertension, bradycardia). Concurrent thyroid administration maypeffectiveness. May alter the effectiveness of
insulins or oral hypoglycemic agents (dosage adjustments may be necessary).
Maypthe effectiveness of theophylline. Maypthe beneficial beta1-cardiovascular
effects of dopamine or dobutamine. Use cautiously within 14 days of MAO inhibitor therapy (may result in hypertension).
Route/Dosage
PO (Adults): Antianginal— 50 mg once daily; may beqafter 1 wk to 100 mg/day
(up to 200 mg/day). Antihypertensive— 25– 50 mg once daily; may beqafter 2 wk
to 50– 100 mg once daily. MI— 50 mg, then 50 mg 12 hr later, then 100 mg/day as a
single dose or in 2 divided doses for 6– 9 days or until hospital discharge.
Renal Impairment
PO (Adults): CCr 15– 35 mL/min— dosage should not exceed 50 mg/day; CCr
⬍15 mL/min— dosage should not exceed 50 mg every other day.
CAPITALS indicate life-threatening, underlines indicate most frequent.
Strikethrough ⫽ Discontinued.
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Name /bks_53161_deglins_md_disk/atenolol
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Plate # 0-Composite
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● Teach patient and family how to check pulse and BP. Instruct them to check pulse
NURSING IMPLICATIONS
Assessment
● May cause drowsiness or dizziness. Caution patients to avoid driving or other ac-
daily and BP biweekly and to report significant changes.
● Monitor BP, ECG, and pulse frequently during dosage adjustment period
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and periodically throughout therapy.
Monitor intake and output ratios and daily weights. Assess routinely for
HF (dyspnea, rales/crackles, weight gain, peripheral edema, jugular venous distention).
Monitor frequency of prescription refills to determine adherence.
Angina: Assess frequency and characteristics of angina periodically throughout
therapy.
Lab Test Considerations: May causeqBUN, serum lipoprotein, potassium,
triglyceride, and uric acid levels.
May causeqANA titers.
May causeqin blood glucose levels.
Toxicity and Overdose: Monitor patients receiving beta blockers for signs of
overdose (bradycardia, severe dizziness or fainting, severe drowsiness, dyspnea,
bluish fingernails or palms, seizures). Notify physician immediately if these signs
occur.
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Potential Nursing Diagnoses
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Decreased cardiac output (Side Effects)
Noncompliance (Patient/Family Teaching)
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Implementation
● PO: Take apical pulse before administering drug. If ⬍50 bpm or if arrhythmia oc-
curs, withhold medication and notify physician or other health care professional.
Patient/Family Teaching
● Instruct patient to take atenolol as directed at the same time each day, even if feel-
ing well; do not skip or double up on missed doses. Take missed doses as soon as
possible up to 8 hr before next dose. Abrupt withdrawal may cause life-threatening
arrhythmias, hypertension, or myocardial ischemia.
● Advise patient to make sure enough medication is available for weekends, holidays, and vacations. A written prescription may be kept in wallet in case of emergency.
tivities that require alertness until response to the drug is known.
Advise patients to change positions slowly to minimize orthostatic hypotension.
Caution patient that atenolol may increase sensitivity to cold.
Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken, to avoid alcohol, and to consult health
care professional before taking any new medications, especially cold preparations.
Patients with diabetes should closely monitor blood glucose, especially if weakness, malaise, irritability, or fatigue occurs. Medication does not block sweating as
a sign of hypoglycemia.
Advise patient to notify health care professional if slow pulse, difficulty
breathing, wheezing, cold hands and feet, dizziness, light-headedness,
confusion, depression, rash, fever, sore throat, unusual bleeding, or
bruising occurs.
Instruct patient to inform health care professional of medication regimen before
treatment or surgery.
Advise female patient to notify health care professional if pregnancy is planned or
suspected, or if breast feeding.
Advise patient to carry identification describing disease process and medication
regimen at all times.
Hypertension: Reinforce the need to continue additional therapies for hypertension (weight loss, sodium restriction, stress reduction, regular exercise, moderation of alcohol consumption, and smoking cessation). Medication controls but
does not cure hypertension.
Evaluation/Desired Outcomes
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Decrease in BP.
Reduction in frequency of angina.
Increase in activity tolerance.
Prevention of MI.
Why was this drug prescribed for your patient?
䉷 2015 F.A. Davis Company
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